This paper aims to deconstruct and synthesize two opposing perspectives on the issue of physician©\assisted suicide. Ira Byock, a physician and leader in the hospice and palliative care movement, believes that a ¡°good death¡± is, by definition, one that occurs naturally. Consistent with hospice movement ideology, he rejects physician©\assisted suicide as antithetical to the affirmation of life. By contrast, philosophy professor David McKenzie supports an individual¡¯s right to elect physician©\assisted suicide as a means of ending suffering and therefore ensuring a good death. Both Byock and McKenzie draw upon myriad sources of knowledge, often overlapping in their reasoning and occasionally in their perspectives.
Across lines of race, religion, and culture, the eventuality of death is an unwavering certainty. Perspectives on what constitutes a good or favorable death are myriad and often disparate. One of the most hotly contested topics related to death and dying in recent years is physician©\assisted suicide, a process by which one who is suffering on the path of dying is granted help from a medical professional in hastening death. Divergent viewpoints on this practice abound. For Ira Byock, M.D., physician©\ assisted suicide is an unacceptable practice that negates the fundamental significance of life (Byock, 2007). Conversely, philosophy professor David McKenzie supports the legalization of physician©\assisted suicide as a means to dying well (McKenzie, 2004). Both of their perspectives draw upon several sources of knowledge that lead to their divergent conclusions.
Dr. Ira Byock has been active in the hospice movement for many years. Hospice and palliative care ideologies firmly reject physician©\ assisted suicide. Byock has actively participated in protesting the legalization of physician©\ assisted suicide. In ¡°To Life! Reflections on Spirituality, Palliative Practice, and Politics,¡± he mentions that some of his activism has been in conjunction with efforts of faith©\based organizations, including fundamentalist Christian groups (p. 438). Byock comes from a Jewish background, and although not particularly observant of religious rituals, he posits that, regardless of religious affiliation, a ¡°reverence for life¡± is inherent in human spirituality (p. 437). It is through this broadly spiritual lens that Byock builds his central argument. His views may seem enmeshed in religious ideology and have thus been met with suspicion from secular opponents, and Byock himself acknowledges the controversial nature of his beliefs and the mission of hospice.
An ironic shift arises when Byock describes an aspect of the ¡°good death debate¡± on which religious and political agendas diverge. In 2004, a bill, initiated in New Hampshire, sought to loosen restrictions on updating advance death directives. This was an effort that Byock supported, a position consistent with his adherence to the hospice and palliative care mission to allow individuals to die naturally when death is imminent, without undesired artificial nutrition or resuscitation. Byock explains how the bill was ¡°hijacked¡± by the far Right in the wake of Terri Schiavo¡¯s death; bureaucrats inserted language requiring those without an advance directive to undergo medically©\administered nutrition, hydration, and cardiopulmonary resuscitation before allowing them to die (p. 437). In Byock¡¯s conception, these requirements were intended to be symbolically meaningful, yet made no biological sense. Thus, it would seem that the far Right is suggesting that death is somehow optional.
While Byock acknowledges the inevitability of death, he endorses a life©\affirming view throughout the article, quoting the late Cardinal Bernadin of Chicago, who stated ¡°that even a person who decides to forgo treatment does not necessarily choose death. Rather, he chooses life without the burden of disproportionate medical intervention.¡± This statement encompasses both a reverence for life and acceptance of death. Byock weaves together his perspective from scientific, spiritual, intuitive, and experiential knowledge. However his stance on allowing life to continue as paramount over ending extreme suffering might be inadequately supported. While his experience and varied sources of knowledge lend much clout to his position, his case against physician©\assisted suicide seems to be highly personal, thus discounting situations in which allowing life to continue may feel less affirmative and more punitive to the terminally ill person in question. And while the hospice and palliative care movement offers holistic support for dying patients, it is still possible that a good death to some patients cannot be achieved through the individual control exemplified by physician©\assisted suicide.
In stark opposition to Byock, in ¡°Church, State, and Physician©\Assisted Suicide¡±, David McKenzie analyzes the position of Justice Stephen Reinhardt of the 9th Circuit Court of Appeals underlying the decision in ?Compassion in Dying? v. ?Washington? (1996), which upheld a patient?s constitutional right to physician©\ assisted suicide. McKenzie strives to reinforce the validity in Reinhardt¡¯s reasoning, as it was called into question when the Supreme Court overturned this decision. Through careful examination of Reinhardt¡¯s arguments, McKenzie seeks to credit the judge, thus presenting an in depth critique of the Supreme Court decision to overthrow this case.
Reinhardt cites constitutional rights to liberty in determining the time and manner of one¡¯s own death as the foundation of his argument (p. 791). To bolster this point, he references existing laws which allows for cessation of life support for terminally ill patients, thereby demonstrating a hands©\off provision that effectively parallels physician©\assisted suicide. McKenzie concurs with Reinhardt¡¯s position, subsequently questioning why the time and manner of one¡¯s own death in the face of profound personal hardship should be limited by government, and arguing that this is essentially an issue of separation of church and state. McKenzie also mentions that current social attitudes toward physician©\assisted suicide show widespread acceptance of the practice.
McKenzie¡¯s philosophically based argument is consistent with his occupation and apparent perspective; he staunchly rejects religion as a basis for making decisions appropriate to governing human life. While his argument in favor of physician©\assisted suicide seems both viable and well©\rendered, his personal bias toward religion discounts his categorical dismissal of the validity of religious perspectives in determining individual rights and decisions. Nonetheless, he has a strong basis for arguing that the law should not be based upon religious decree. Although he does not explicitly address political affiliation in this article, his support for the liberal Reinhardt in opposition to a conservative values©\based decision suggests that he disagrees with the agenda of the political right©\wing. McKenzie¡¯s perspective is an interesting parallel to Ira Byock¡¯s. While McKenzie suggests that religious ideology is enmeshed in the conservative perspective to the extent that it undermines their argument, Byock would argue that its influence is only on the far Right.
In the widely contested debate over physician©\assisted suicide, the argument seems to hinge upon whether religious or other ideological influences are inseparable from political stances. Ira Byock essentially argues that the political agenda of the far right is counteractive to key aspects of the hospice and palliative care mission. He alludes to the view of the far Right which equates the hospice movement¡¯s honoring of do©\not©\resuscitate orders by allowing a person to die without a feeding tube with murder. That being said, Byock himself draws the core of his viewpoint from spirituality in addition to experience, intuition, and science. David McKenzie is similarly opposed to judicial action that reflects a conservative agenda with regard to death and dying, arguing that the political decisions of the right, exemplified by Justice Rehnquist, are entangled in a religious agenda and thereby violate legitimate liberty interests of United States citizens.
Byock, I.R. (2007). To life! Reflections on spirituality, palliative practice, and politics. American Journal of Palliative Medicine, 23(6), 436©\438.
McKenzie, D (2004). Church, state, and physician©\assisted suicide. Journal of Church and State, 46(4), 787©\809.
About the Author
Dana Kragh is a graduate of Ithaca College, where she majored in psychology. For her first©\year placement she worked with seniors at the Rodney Kirk Center at Manhattan Plaza. Her major method at HCSSW is Clinical Practice with Individual and Families. Mr. Kragh can be reached at firstname.lastname@example.org.